Cell Salvage in the Management of Postpartum Hemorrhage: A Comprehensive Review of the Current Literature

Postpartum hemorrhage (PPH) remains a leading contributor in maternal illness and death worldwide, and its incidence continues to rise. This has led to an increased reliance on allogeneic blood transfusions (ABT), which are limited in supply and carry significant health risks. Cell salvage (CS), which collects and transfuses a patient's own blood, has been proposed as a useful adjunct or alternative. This narrative review aims to evaluate and summarize the current literature on obstetric CS (OCS) in the management of PPH, with a focus on efficacy, safety, cost-effectiveness, and future research considerations. A literature search was performed using PubMed and Google Scholar, leading to the selection and review of 32 original articles published from 2015 onward. Single case reports, meta-analyses, and other review articles were excluded to minimize amplification bias and ensure an authentic analysis of primary research data. OCS has been shown to reduce the need for donor blood, especially during high-risk cesarean sections, including those with placenta previa and placenta accreta spectrum. Reported benefits include improved maternal hemoglobin, reduced transfusion-related complications, and shorter hospital stay. However, not all the results were statistically significant for reductions in allogeneic transfusion rates. Safety concerns associated with the use of OCS, including amniotic fluid embolism, sepsis, hemolysis, coagulopathy, and Rh alloimmunization, have been substantially addressed through advancements in technology, the implementation of leukocyte depletion filters, and the routine administration of anti-D prophylaxis. Evidence for its use in vaginal deliveries remains sparse, though early studies suggest technical feasibility. Cost-effectiveness is debated and appears dependent on institutional protocols, case volume, and technique optimization. OCS represents a safe and valuable blood-conservation strategy in obstetric practice, particularly for high-risk cesarean section. Wider adoption requires standardized protocols, staff training, and further multicenter research to clarify its role, especially in vaginal deliveries.